Our affiliate providers can access any forms necessary for managing a client case on this webpage. Just click on any of the links listed below to access and download the selected form.
Empathia, Inc.
Trauma Response Services Form: please call for a copy.
Empathia Pacific
Instructions and Forms for Provider Dispute Resolution Request
Statement of Understanding & Consent to Participate
Statement of Understanding & Consent to Participate – Spanish
Notice of Privacy Practices – Spanish
Authorization for Disclosure of Confidential Information
Authorization for Disclosure of Confidential Information – Â Spanish